Endocarditis Prophylaxis According to Recent ESC-Guidelines

In 2009, the European Society of Cardiology has published new guidelines for the prevention, diagnosis and treatment of infective endocarditis (IE). As in previous recommendations, the high importance of good oral hygenie and of aseptic measures during venous catheters manipulation and any invasive procedures for the reduction of the risk of endocarditis are emphasized. However, the approach to antibiotic endocarditis prophylaxis differs dramatically from previous guidelines. Rather by expert consensus then by new scientific evidence, its recommendation is now limited to patients with the highest risk of IE (mainly patients with prosthetic valves or other nonendothelialized prosthetic material, with previous IE and with certain congenital heart disease) undergoing the highest risk procedures (mainly dental procedures). The main arguments for this change are the following: transient bacteraemia does not only occur after dental procedures but frequently in the context of daily routine activities such as tooth brushing or chewing; there is a lack of scientific evidence for the efficacy of antibiotic prophylaxis; a huge number of patients may need to be treated to prevent one single case of IE; there is a small but existing risk of anaphylaxis and the general problem of emergence of resistant microorganisms resulting from widespread, often inappropriate use of antibiotics. This article summarized the current recommendations and provides the background.